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Health Care Attorney in Cambridge, MA

Aetna Inc. Oct 01,2014 Sep 08,2014 Location USA Cambridge MA
This job is expired...

In-House

Attorney

Health Care

Litigation - Whistleblower - CFTC

3-5 yrs required

Profile

Senior Director, Compliance Duties: Responsibility for leading and directing the Medicare Part D compliance team which is part of the Medicare Compliance Organization. Given the ever-changing Medicare regulatory environment, the Senior Director of Compliance plays a key role within the Medicare Compliance organization. Maintain a strong relationship with appropriate counterparts at the Centers for Medicare and Medicaid Services and department heads. Promotes and enforces compliance with CMS regulations and related-company policies affecting business and encourages high business standards in order to advance company objectives, benefit the company's customers, employees and shareholders, and protect the company's reputation. Implements, leads and maintains a Medicare Part D Compliance program and related regulatory oversight activities. Leading a team of Medicare Part D regulatory subject matter experts (i.e., Adjudication, Coverage Determination, Appeals, Grievance, PDEs, and Clinical) to understand and interpret CMS regulatory expectations/intent as it applies to Medicare Part D. Monitors CMS regulations and provides direction for and expertise in Medicare Part D Program to ensure administrative and operational activities comply with regulations. Maintains current working knowledge and expertise in Medicare Compliance with a focus on Compliance Program Effectiveness. Conducts monitoring and auditing for each functional Part D area as outlined in Medicare Compliance Work Plan to evaluate compliance; proposes corrective action where necessary and monitors implementation of such corrective action. Documents compliance activities and maintains a file with appropriate evidence of compliance. Provides status and final reports to Executive Management for ongoing compliance monitoring activities. Interfaces with industry groups and regulators on compliance with laws and regulations. Provides ongoing consultation on compliance issues impacting businesses. Participate in and manage Performance Management Review process for direct reports. Exhibits the following Senior Director, Compliance behaviors: Anticipate and respond to future risk situations. Apply business knowledge to move the business forward. Craft and over-see work practices to drive performance. Serve as an spokesperson. Develop a workforce that creates competitive advantage. Find solutions to atypical or complex constituent issues. Create a culture of continuous improvement.

Qualification and Experience

Qualifications: B.A. / B.S. degree in Healthcare or related field required. Masters or higher degree in Law, Business, Health Care or other applicable area preferred. License in Healthcare Management, Pharmacy, Business, Legal, are desired. 3-5 years in regulatory/compliance mgmt in Medicare Part D, experience with CMS Regional & Central Office. Strong leadership skills, working cross functionally, managing staff and project mgmt in a large corporate environment.

Additional info

Req# 19540BR

Company info